Your Digest for Wednesday, Dec 27, 2023 09:59 PM


porphyrias.png

[!TIP] Patient (esp. Female) with abdominal pain + neuropsychiatric features -> need to consider acute porphyria.


mycosisFungoides.jpeg

Sezary syndrome


    1. Overnight 1mg dexamethasone suppression test

Indications for ICU care (according to SL guidelines)

Complications of leptospirosis

Renal


Psoriatic arthritis is associated with HLA-B27.

Imaging

Psoriatic arthritis Vs. Rheumatoid arthritis

Differentiation is clinically important because prognosis and management are different.

PsA RA
better prognosis Somewhat worse
Early disease -> NSAIDS DMARDs started early
Dactylitis, enthesistis, tenosynovitis -
pattern: asymmetric oligo / symmetric, DIP is specific Symmetric polyarthritis of PIP / MCP
Sacroiliitis -
Nail changes -
- proximal hand and foot involvement (?wrist and ankles)
Source

Summary of enzymes involved

HMG-CoA reductase: Rate limiting enzyme in cholesterol sythesis : found in the liver and ? other tissues
LCAT : the enzyme synthesized by the liver and attached to HDL which exterifies cholesterol so that it becomes trapped inside HDL. Required for reverse transport of cholesterol.
LPL: lipoprotein lipase: the enzyme found on tissues which removes lipids from VLDL and it's derivatives, increasing their density.
If there is acidosis (pH < 7.2 or HCO3 < 15) or high ketonemia, manage as DKA.
++ /dev/null


Loss of this function leads to leads to chronic complement mediated haemolysis, more pronounced at night during hypoxia. (Dark urine in the morning)


+ it is **non pruritic**, starts on the abdomen and **spreads *outwards***. (Spares palms and soles) 

Trombiculid mite = 'harvest' mite

Endemic typhus serves as the prototype for pathogenesis:
++ /dev/null


[!INFO] DCT physiology

Inheritance: #autosomal-Recessive

These changes (except the lack of hyponatremia) are very similar to changes caused by chronic thiazide use.
2. It causes recurring episodes of microscopic or gross haematuria lasting a few days. Usually recurs every few months after the onset. Can present as microscopic haematuria as well.
1. in PSGN, the haematuria develops 1-2 weeks after the respiratory infection.
4. Begins with haematuria 1-2 days after non specific upper respiratory tract infection. (said to be conincidental with the infection)
5. Pathogenesis may be due to dysregulated mucosal type IgA responsones (see K and C page 1362)
6. Hallmark is IgA deposition in the mesangium. (Mesangial deposist are granular deposits)
7. May be related to Henoch Schonlein purpura which has mesangial IgA deposition as well as systemic involvement.
3. Proteinuria > 1g day (if so, 25% progress to ESKD)
6. Apparently presence of macroscopic haematuria is a good prognostic factor because patients present earlier.


Symptoms Usually more prominent on one side at first but then become bilateral.

Main motor symptoms Others
Tremmor, akinesia, ridigity Writing becomes smaller, mask like face *

Other motor symptoms:

  - Domperidone **does not cross the blood brain barrier**

8. Endocrine: reduced testosterone (due to Leydig cell dysfunction) [Source](https://emedicine.medscape.com/article/120858-overview)



Interface hepatitis is seen, just like autoimmune hepatitis.
++ /dev/null


🔖Extrahepatic manifestations of hepatitis B



Symptoms : N/V, headache,
motor effects: nystagmus, tremor, cerebellar ataxia.

Phenytoin side effects

++ /dev/null
++ /dev/null


Antipsychotic drugs

antipsychoticDrugClassifications.jpg


*** *** - **Commonest** systemic effects are **VICC** - venom induced consumption coagulapathy (venom has a procoagulant effect) and **AKI** - **but overt bleeding usually doesn't occur**. Therefore, | Drug | Antidote | | ---- | ---- | | Kaneru | | | | | | | | ***

Causes of hyperprolactinaemia

#2023GM-NOV/Q30
Pathological causes

Drugs: